Citation Nr: 1318581 Decision Date: 06/07/13 Archive Date: 06/11/13 DOCKET NO. 09-24 376 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Des Moines, Iowa THE ISSUES 1. Entitlement to service connection for a psychiatric disability claimed as posttraumatic stress disorder (PTSD) and diagnosed as anxiety disorder. 2. Entitlement to service connection for a respiratory disability, claimed as a disability to the chest and ribs, and diagnosed as chronic obstructive pulmonary disorder (COPD). 3. Entitlement to service connection for bilateral hearing loss. 4. Entitlement to service connection for tinnitus. 5. Entitlement to service connection for a right knee disability. 6. Entitlement to service connection for a right ankle disability. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Veteran & spouse ATTORNEY FOR THE BOARD B. Thomas Knope, Counsel INTRODUCTION The Veteran served on active duty from February 1981 to July 1986. This matter is on appeal from ratings decision in May 2008 and March 2010 by the Department of Veterans Affairs (VA) Regional Office (RO) in Des Moines, Iowa. The Veteran testified before a Decision Review Officer (DRO) in December 2011 and before the undersigned Veterans Law Judge in March 2013. Transcripts of the hearings are of record. Although the Veteran originally submitted a claim for a disability to the "chest, ribs and lungs," the evidentiary and procedural development of this issue has been centered primarily on his respiratory complaints. He has not alleged that he has a current disability to the ribs or any other organ in the chest. Moreover, while he has characterized his psychiatric disability claim as a "nervous condition," VA must consider entitlement to service connection for any psychiatric disability that may reasonably be encompassed by evidence of record. Clemons v. Shinseki, 23 Vet. App. 1 (2009). In this case, he has effectively asserted that he has PTSD, and the record indicates that he has been treated for an anxiety disorder. FINDINGS OF FACT 1. A chronic knee or ankle disability, tinnitus, a respiratory disability, and an anxiety disability (other than PTSD) were not shown in service or for many years thereafter, and none of the disabilities are shown to be related to service. 2. PTSD and bilateral hearing loss disability are not currently shown. CONCLUSIONS OF LAW 1. A psychiatric disability claimed as PTSD and diagnosed as anxiety disability was not incurred in or aggravated by service, and is not related to service. 38 U.S.C.A. §§ 1131, 5103(a), 5103A (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 3.303, 3.304 (2012). 2. A respiratory disability, claimed as a disability to the chest and ribs, and diagnosed as COPD, was not incurred in or aggravated by service, and is not related to service. 38 U.S.C.A. §§ 1131, 5103(a), 5103A (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 3.303, 3.304 (2012). 3. Bilateral hearing loss was not incurred in or aggravated by service, is not related to service, and is not currently shown. 38 U.S.C.A. §§ 1131, 5103(a), 5103A (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 3.303, 3.304 (2012). 4. Tinnitus was not incurred in or aggravated by service, and is not related to service. 38 U.S.C.A. §§ 1131, 5103(a), 5103A (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 3.303, 3.304 (2012). 5. A right knee disability was not incurred in or aggravated by service, and is not related to service. 38 U.S.C.A. §§ 1131, 5103(a), 5103A (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 3.303, 3.304 (2012). 6. A right ankle disability was not incurred in or aggravated by service, and is not related to service. 38 U.S.C.A. §§ 1131, 5103(a), 5103A (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 3.303, 3.304 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist VA has a duty to notify and assist claimants in substantiating claims for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Proper notice from VA must inform the claimant and his representative, if any, prior to the initial unfavorable decision on a claim by the agency of original jurisdiction (AOJ) of any information and any medical or lay evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. 38 U.S.C.A. § 5103(a) (West 2002); 38 C.F.R. § 3.159(b) (2012); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004); Quartuccio v. Principi, 16 Vet. App. 183 (2002). These notice requirements apply to all five elements of a service-connection claim (Veteran status, existence of a disability, a connection between the Veteran's service and the disability, degree of disability, and effective date of the disability). Information that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded must be included. Dingess v. Nicholson, 19 Vet. App. 473 (2006). Neither the Veteran nor his representative has alleged prejudice with respect to notice, as is required, and none is found by the Board. Shinseki v. Sanders, 556 U.S. 396 (2009); Goodwin v. Peake, 22 Vet. App. 128 (2008); Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112 (2007). The duty to notify was satisfied by letters sent to the Veteran in June 2007 and August 2009 that fully addressed all notice elements and was sent prior to the initial RO decisions in this matter. The letters informed him of what evidence was required to substantiate the claims and of his and VA's respective duties for obtaining evidence. They also provided the Veteran with notice of what type of information and evidence was needed to establish a disability rating, as well as notice of the type of evidence necessary to establish an effective date. Therefore, adequate notice was provided to the Veteran prior to the transfer and certification of his case to the Board and complied with the notice requirements. 38 U.S.C.A. § 5103(a) (West 2002); 38 C.F.R. § 3.159(b) (2012). VA also has a duty to assist a Veteran in the development of a claim. That duty includes assisting him in the procurement of service medical records and other pertinent records, and providing an examination when necessary. 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159 (2012). After a careful review of the file, the Board finds that all necessary development has been accomplished, and therefore appellate review may proceed without prejudice to the Veteran. Bernard v. Brown, 4 Vet. App. 384 (1993). The RO has obtained the Veteran's service medical records and VA outpatient treatment records. Further, the Veteran submitted treatment records from a private facility and his own statements in support of his claims. VA examinations with respect to the issues on appeal were also obtained in February and November 2009. 38 C.F.R. § 3.159(c)(4) (2012). When VA undertakes to provide an examination, it must ensure that the examination is adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). The Board finds that the VA examinations obtained in this case is adequate. It is predicated on a full understanding of the Veteran's medical history, and provides a sufficient evidentiary basis for the claim to be adjudicated. Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion has been met. 38 C.F.R. § 3.159(c)(4) (2012). While a VA medical opinion was not obtained to determine the nature and etiology of the claimed psychiatric disability, the Board notes that a VA medical examination is not required as a matter of course in virtually every veteran's disability case involving a nexus issue. Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010). Rather, in determining whether the duty to assist requires that a VA medical examination be provided or medical opinion obtained with respect to a veteran's claim for benefits, there are four factors for consideration: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the veteran's service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C.A. § 5103A(d) (West 2002); 38 C.F.R. § 3.159(c)(4) (2012). In this case, there is no evidence of any psychiatric disability in service, and a diagnosis of PTSD has not been shown. Therefore, there would not be a reliable basis for an opinion by a VA examiner. Therefore, the Board finds that a remand for a VA opinion would not be beneficial in the adjudication of this issue to the extent that it was denied, and is thus not required in this case. The Board finds that no further notice or assistance is required to fulfill VA's duty to assist in the development of the claim. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131 (West 2002). Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498 (1995). In some cases, service incurrence and relationship to service may be established through a demonstration of continuity of symptomatology for certain specific chronic disabilities. 38 C.F.R. § 3.303(b) (2012); Barr v. Nicholson, 21 Vet. App. 303 (2007). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was noted during service; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Savage v. Gober, 10 Vet. App. 488 (1997). However, service-connection may be established under 38 C.F.R. § 3.303(b) only for chronic disabilities listed in 38 C.F.R. § 3.309(a). While disabilities related to degenerative arthritis, tinnitus, and sensorineural hearing loss are considered chronic, non-psychotic psychiatric disabilities, and non-malignant tumor respiratory disabilities are not considered chronic diseases and may not be service connected under 38 C.F.R. § 3.303(b). 38 C.F.R. § 3.309(a) (2012); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Nevertheless, evidence of continuous symptoms since active duty is still a factor for consideration as to whether a causal relationship exists between an in-service injury or incident and the current disability as is contemplated under 38 C.F.R. § 3.303(a). Moreover, service connection will also be presumed for the chronic disabilities such as tinnitus, sensorineural hearing loss, and arthritis, if manifest to a compensable degree within one year after discharge from service. 38 C.F.R. §§ 3.307, 3.309 (2012). Service connection may only be granted for a current disability. When a claimed disability is not shown, there may be no grant of service connection. 38 U.S.C.A. § 1110 (West 2002); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). Congress specifically limited entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223 (1992). VA must give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability or death benefits. 38 U.S.C.A. § 1154(a) (West 2002); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). In this case, the Veteran's claims are best characterized by the assertions he made at his hearing before the Board in March 2013. First, regarding his hearing loss and tinnitus claims, he stated that he was standing next to a tank, when its large gun fired unexpectedly, causing him to have difficulty hearing for a few days and, while his hearing returned, he experienced ringing in his ears since that time. He also recalled being stationed in Germany, when a tank engine exploded. Regarding his chest and respiratory disability, the Veteran explained that he was performing maintenance on a vehicle, when it was driven over his chest. While he stated that he was hospitalized for over a week at an off-post facility, he could not remember the name of that facility. Due to that incident, he stated that he had difficulty sleeping. His spouse also stated that she had observed the Veteran experience breathing difficulty. The Veteran next stated that he incurred a psychiatric disability following an incident where he saw a tank hit an electrical wire, killing three servicemen, although he was unable to remember their names. Finally, concerning his right knee and ankle complaints, he stated that he was changing a truck tire, when it was dropped on his leg and "threw everything out of socket." He was taken to Darnall Hospital at Fort Hood for treatment. There are additional VA regulations to consider when addressing entitlement to service connection for sensorineural hearing loss and PTSD. Therefore, those disabilities are considered separately. However, after a review of the evidence, the Board determines that service connection is not warranted for any of the issues on appeal. Right Ankle Disability, Right Knee Disability, Tinnitus, Anxiety Disorder, and Respiratory Disability The Board first addresses the Veteran's claims related to his right knee, right ankle and respiratory disabilities, and for tinnitus and any psychiatric disorder other than his PTSD. As an initial matter, the service medical records indicate that he was seen on a number of occasions for respiratory symptoms. For example, in January and April 1982, he was seen for complaints of headaches and respiratory problems such as chest pains and coughing. He was diagnosed with possible bronchitis and in the April evaluation, there was no indication of any further treatment. He was seen again soon thereafter for complaints of chest pain. However, that pain was associated with a chest cold, and no follow-up treatment was indicated. With regard to his right knee and ankle complaints, the service medical records show that he was seen for complaints of right leg and foot pain in November 1983 when he jumped from a truck and landed on a rock. Swelling and discoloration was observed upon examination of the right foot. While he was diagnosed with a mild right ankle sprain, there was no indication of follow-up treatment. The Veteran also was seen on two occasions for complaints of a "trick" knee in November 1983 and March 1984. At both evaluations, he stated that his knee gave out intermittently, but he denied any history of previous injuries or any knee pain. At the November 1983 evaluation, no discoloration or edema or crepitus was noted, and his strength was normal. The service medical records do not show complaints of, treatment for, or a diagnosis related to any psychiatric disability or tinnitus while in service. Although the Veteran was treated for disabilities that may be similar to the ones he claims currently, it is significant that a periodic physical examination in September 1985 did not indicate the presence of any persistent right knee, right ankle, or respiratory disabilities. Moreover, there was no indication of tinnitus or any psychiatric disability. In fact, despite treatment he received, he denied any significant medical history. Although the he did not separate from active duty until July 1986, he specifically declined a separation medical examination. The post-service evidence also does not show symptoms related to any of the claimed disabilities for many years after the Veteran left active duty service. Specifically, while the record indicates that he was treated for Tourette's disorder since at least 2004, the first diagnosis of a psychiatric disability was not until May 2007. Despite being diagnosed with anxiety disorder, he did not identify any symptoms of depression or anxiety. Similarly, a chronic respiratory disability was not identified in the record until November 2006, where was diagnosed with COPD, characterized by hyper-expansion of the lungs with perihilar and infrahilar markings. With regard to the Veteran's right knee and ankle complaints, there was no indication of any right knee complaints until September 2005, where he was evaluated for bilateral knee complaints, with the right knee being worse than the left. It is also unclear whether a right ankle disability has ever been actually diagnosed, as an X-ray of the right ankle revealed only a small amount of plantar spurring. Even so, if the plantar spurring were to constitute a current ankle disability, it was not identified until November 2009. In each case, the Board emphasizes that it was many years between the time the Veteran separated from active duty in 1986 and his current complaints. In fact, the first indication of any of the disabilities on appeal, his right knee, was not mentioned until approximately nineteen years after he left active duty. Therefore, a continuity of symptoms is not shown based on the clinical evidence for any of the claimed disabilities. Moreover, even though service connection for a disability such as non-psychotic disabilities or respiratory disabilities may not be shown simply based on continuity of symptoms, such a large gap in treatment also weighs against a finding that the claimed disabilities are related to service. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). When considering the presence of symptoms since service, the Board has also considered the Veteran's statements asserting continuity of symptoms. McClain v. Nicholson, 21 Vet. App. 319 (2007)( Board is required to assess the credibility and probative weight of all relevant evidence, including the credibility of the Veteran's statements). In doing so, the Board may consider factors such as facial plausibility, bias, self interest, and consistency with other evidence of record. Caluza v. Brown, 7 Vet. App. 498 (1995); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). Competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67 (1997); Layno v. Brown, 6 Vet. App. 465 (1994); Cartright v. Derwinski, 2 Vet. App. 24 (1991) (although interest may affect the credibility of testimony, it does not affect competency to testify). The Veteran is competent in some cases to diagnose some disabilities despite his status as a lay person. Tinnitus is one such example as it is observable with the sense. However, he is not competent diagnose musculoskeletal disabilities such as the ones he is claiming here, psychiatric disabilities, or respiratory disabilities. Rather, those are disabilities that may not be diagnosed by unique and readily identifiable features, and thus require a determination that is medical in nature. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).. Nevertheless, the Veteran's lay testimony is competent to establish the presence of observable symptomatology and may provide sufficient support for a claim of service connection, if credible, regardless of the lack of contemporaneous medical evidence. Barr v. Nicholson, 21 Vet. App. 303 (2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). However, the Board determines that the Veteran's reported history of continued symptomatology since active service, while competent, is nonetheless not credible. In making this determination, the Board may consider internal consistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498 (1995). The Board is not required to accept an appellant's uncorroborated account of his service experiences. Wood v. Derwinski, 1 Vet. App. 190 (1991). First, while the Veteran has complained of PTSD-type symptoms, he has not claimed to have experienced psychiatric symptoms continuously since service. When he was originally diagnosed with an anxiety disorder in 2007, he denied any psychiatric symptoms. Moreover, while he was diagnosed with COPD in November 2006, he was specifically observed to have no active cardiovascular disability only months earlier in May 2006. Additionally, the Veteran did not file his claim for service connection for any of the claimed disabilities for at least 19 years after he left active duty. Shaw v. Principi, 3 Vet. App. 365 (1992) (delay in asserting a claim can constitute negative evidence that weighs against the claim). Therefore, the Board finds that continuity is not established based on the clinical evidence of record or the Veteran's statements. Next, service connection may also be granted when the evidence establishes a medical nexus between active duty service and current complaints. In this case, the Board finds that the weight of the competent evidence does not attribute the claimed disabilities to active duty, despite the Veteran's contentions to the contrary. First, regarding his claimed respiratory disability, the Board places significant value on the opinion of a VA examiner who evaluated the Veteran's symptoms in February 2009. The Veteran recounted the incident where he was partially run over by a vehicle and was treated at a medical facility for injuries. He also stated that his chest was wrapped due to bruising, but did not experience any severe symptoms such as coughing blood. Since that time, he experienced chest pains that occurred periodically. Upon examination, the Veteran indicated that he smoked from one to four packs per day, and that he experienced shortness of breath when exerting himself. There was no history of emphysema or asthma. The examiner also noted that the Veteran had very poor posture that inhibited his breathing. Radiographic imaging of the chest revealed no acute lung disease. The examiner diagnosed COPD, but opined that it was less likely than not that his COPD was related to his active duty service. In providing that opinion, the examiner noted that the Veteran had a history of high tobacco use and dependence that was known to lead to chest and lung disabilities. The Veteran's unusual posture, which was highly kyphotic, additionally limited his breathing. Moreover, there was no documentation that the Veteran experienced a severe chest injury in service and, his stated injuries were limited to bruising, which usually healed without sequelae. Finally, although the Veteran has characterized his disability as one to the chest in general, no active lung or chest wall disabilities were observed. With regard to his right knee and ankle complaints, the Veteran underwent a VA examination in November 2009. The examiner noted that the September 1985 periodic examination was normal, as was a subsequent examination he underwent before entering the Navy Reserve in 1991. The examiner also noted the treatment the Veteran received for a sprained ankle in service, and his complaints of a "trick knee." The examiner did not mention the incident where a tire was dropped on his leg. Upon examination, the Veteran exhibited only a slightly limited range of motion in both the ankle and knee and, while X-rays indicated small amounts of spurring in the tendons around both joints, there was no actual pathology to the joints themselves. After the examination was concluded, the examiner opined that the Veteran's knee and ankle disabilities were not related to his active duty service. In providing that opinion, the examiner noted that the Veteran's complaints of a "trick knee" did not result from any injury, and there was no actual pathology resulting from those complaints. Moreover, there were no subsequent knee complaints in his 1985 and 1991 examinations. With regard to the Veteran's ankle sprain, the examiner noted that there were no reported residuals from any active duty injury, which is consistent with the natural history of that minor history. The examiner again noted that there were ankle symptoms mentioned or observed at subsequent examinations in 1985 and 1991. Concerning his tinnitus complaints, the Veteran underwent a VA audiological examination in November 2009, where he stated that he was routinely exposed to gunfire and tank cannon fire while in service. He also acknowledged some post-service noise exposure while working in a warehouse. However, after reviewing the Veteran's service medical records, the examiner opined that it was less likely as not that tinnitus was related to active duty service. In providing that opinion, the examiner noted that there were no complaints of tinnitus for 23 years after he left active duty. The Board finds that the examinations are adequate for evaluation purposes. Specifically, the examiners reviewed the claims file, interviewed the Veteran, and conducted a physical or audiological examination. There is no indication that the VA examiner was not fully aware of the Veteran's past medical history or that he misstated any relevant fact. As for the Veteran's diagnosed anxiety disorder, none of the clinical evidence indicates that disability existed during active duty, or that it his current symptoms are related to his active duty service. Of particular note, no treating professional has asserted such a relationship. Therefore, the Board finds that the preponderance of the evidence is against the claims for service connection for tinnitus, a right knee disability, a right ankle disability, and a respiratory disability. Therefore, the claims must be denied. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Hearing Loss Impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater, when the auditory thresholds for at least three of the above frequencies are 26 decibels or greater, or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385 (2012). Moreover, service connection will also be presumed for sensorineural hearing loss, if manifest to a compensable degree within one year after discharge from service. 38 C.F.R. §§ 3.307, 3.309 (2013). While the Veteran underwent several audiograms during active duty service, they were relatively consistent, and none of them demonstrated impaired hearing for VA purposes. Specifically, in May 1981, while his hearing loss was measured at 30 decibels at 4000 Hertz in the right ear, no other frequency was in excess of 10 decibels at any frequency from 500 to 4000 Hertz. In October 1984, his hearing was again 30 decibels at 4000 Hertz in the right ear, but was not in excess of 25 decibels at any other frequency. In June 1986, the Veteran's hearing was 35 decibels at 4000 Hertz in the right ear, but no in excess of 20 decibels at any other frequency. This was also the case at his periodic physical examination in September 1985, where he was at 30 decibels at 4000 Hertz, but not in excess of 20 decibels at any other frequency. Therefore, hearing loss disability for purposes of 38 C.F.R. § 3.385 was not met while on active duty. Moreover, the Veteran post-service records also do not indicate hearing loss disability for VA purposes. Specifically, at his VA examination in November 2009, he stated that he had difficulty hearing since active duty, and was told the same thing by others. However, an audiographic examination indicated no tonal thresholds in excess of 25 decibels at any frequency between 500 and 4000 Hertz or speech recognition scores less than 94 percent. Therefore, the requirements of 38 C.F.R. § 3.385 are not met. Therefore, although the Veteran has complained of hearing loss symptoms, the evidence does not show hearing loss that constitutes a disability for VA purposes. Moreover, the mere assertion of symptoms alone cannot be compensable without an in-service disease or injury to which any asserted symptoms can be connected by competent evidence. Sanchez-Benitez v. West, 25 F.3d 1356 (Fed. Cir. 2001). The Board finds that the preponderance of the evidence is against the claim for service connection for hearing loss and the claim must be denied. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). PTSD In order to establish service connection for PTSD, the evidence of record must include a medical diagnosis of the condition in accordance with 38 C.F.R. § 4.125(a), a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f) (2012). A diagnosis of PTSD must meet the requirements of the American Psychiatric Association's Diagnostic and Statistical Manual on Mental Disorders, Fourth Edition (DSM-IV). 38 C.F.R. § 4.125(a) (2012). Under DSM-IV, a valid diagnosis of PTSD requires that a person has been exposed to a traumatic event in which both of the following were present: (1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of himself or others, and (2) the person's response involved intense fear, helplessness, or horror. If the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(1) (2012). However, where VA determines that the Veteran did not engage in combat with the enemy or that the veteran engaged in combat with the enemy but the claimed stressor is unrelated to the combat, the veteran's lay testimony alone will not be enough to establish the occurrence of the alleged stressor. Instead, the record must contain evidence that corroborates the Veteran's testimony as to the occurrence of the claimed stressor. 38 U.S.C.A. § 1154(b) (West 2002); 38 C.F.R. § 3.304(d), (f) (2012); West v. Brown, 7 Vet. App. 70 (1994). The Veteran claims that he has PTSD as the result of an incident while on active duty, where he witnessed a tank strike an electrical wire, killing three members of the tank crew. While he has not provided any more specific details on this incident, there is no need to verify his asserted stressor, as the Veteran does not have a valid diagnosis of PTSD. Specifically, while the Veteran was originally diagnosed with anxiety disorder in 2007, there was no mention of PTSD. To the contrary, a psychiatric treatment note in July 2007 indicated that a PTSD screen was negative. Moreover, at a later psychiatric evaluation in February 2009, he was observed to have some PTSD symptoms, but his overall psychiatric picture did not meet the threshold requirements for a full diagnosis. Thus, considering the clinical evidence of record, the Board is left to conclude that a diagnosis of PTSD is not shown. Moreover, while the Veteran may complain of certain PTSD type symptoms, mere symptoms alone are insufficient to establish service connection. Sanchez-Benitez v. West, 25 F.3d 1356 (Fed. Cir. 2001). Regarding all claims on appeal, the Board has also considered the statements made by the Veteran relating his disabilities to his active service. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In this case, however, the Veteran is not competent to provide testimony regarding the etiology of ankle and knee disabilities, his respiratory disability or his psychiatric disabilities, as those are not disabilities which may be diagnosed by unique and readily identifiable features, and do not involve a simple identification that a layperson is competent to make. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, the uncorroborated statements regarding the claimed etiology of the claimed disabilities are found to lack competency. Moreover, while the Veteran is competent to diagnose tinnitus, as tinnitus is identified by its symptoms, the Board has found that his statements regarding that disability to be non-credible and outweighed by clinical evidence that does not show any complaint of tinnitus prior to the claim for benefits. The Board finds that the preponderance of the evidence is against the claim for service connection for PTSD and the claim must be denied. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER Service connection for a psychiatric disability, claimed as PTSD and diagnosed as anxiety disorder, is denied. Service connection for a respiratory disability, claimed as a disability to the chest and ribs, and diagnosed as COPD, is denied. Service connection for bilateral hearing loss is denied. Service connection for tinnitus is denied Service connection for a right knee disability is denied. Service connection for a right ankle disability is denied. ______________________________________________ HARVEY P. ROBERTS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs